Background information for the assignment.

You are the RN on a morning shift on the respiratory ward of a large inner-city hospital. At 10:30 AM you receive a patient from the Emergency Department.

This is the hand-over you receive.

Your initial assessment findings on the ward for Ms Abimbola are as follows:

Medications

Metoprolol 100mg daily, Aspirin 100mg daily, Atorvastatin 20mg mane, Glibenclamide (Daonil) 5mg orally daily before breakfast, Salbutamol sulphate (Ventolin) 100mcg inhaler as required for symptom relief (1-2 puffs as required), Fluticasone propionate/salmeterol xinafoate (Seretide) 50/25 inhaler (2 puffs BD)

Current vital observations:

BP 142/96mmHg

HR 96bpm

RR 24 bpm

SpO2 93% on RA

T 36.7C

Health assessment findings:

Height 158cm, Weight 93kg,

Total cholesterol level - 5.2mmol/L

Fasting BGL - 9.6mmol/L

Inspiratory and expiratory wheeze. speaking in short phrases taking 2-3 breaths between each phrase before continuing to speak.

Alert and orientated to time, place, and person.

Further information you gather from her medical history and as part of her admission questions:

Ms Aaliyah Abimbola is a 56 year old female who emigrated from Africa 20 years ago. Ms Abimbola is a single parent with three female children (ages 14, 17 and 18) living in the inner-west of Melbourne.

Ms Abimbola went to her local health care clinic 2 weeks ago complaining of increasing shortness of breath and lack of energy. She says she was given some breathing medication (inhalers) by the doctor and told to take it easy for a few days. She has been struggling to get from the ground floor living area to the upstairs bedrooms without resting half-way to catch her breath. She says sometimes the medication helps her catch her breath but she still has to rest half way even with the medication.

Ms Abimbola has been working at the local flour mill since she arrived in Melbourne from Africa 20 years ago. She has never smoked but says the dust at the flour mill often makes her cough. Her job for the first 3 years was filling bags with flour until that process became fully automated. She then got promoted to running one of the flour grinding machines. 2 years later she got another promotion to shift supervisor in the milling and packaging section. She says her clothes were always covered in white dust at the end of every shift. "I used to look like a ghost at the end on my shift. We all did!" The flour mill made it mandatory to wear a mask and other protective equipment when you're working in the factory about eight years ago. However, Ms Abimbola has been working in the office for the last 6 years and no-one wears protective equipment in the office as it's not necessary. She says there's always a fine layer of dust on the paperwork in the office because the 'flour just gets everywhere no matter how often you clean or how careful you are."

Ms Abimbola is currently averaging 50 hours/week which means she needs to work on most weekends. Since the Covid 19 lockdown the factory has increased production to 24 hours a day 7 days a week. That means the office is also extremely busy. Ms Abimbola has always accepted any overtime on offer to help pay the rent for their house and cover the school fees for the Catholic school her children attend. She is adamant that she wants them to get a good education so they can make the most of the opportunities she never had in Africa. She has always been socially active within her Church community, but due to her increased working hours this has restricted her ability to attend mass and contribute to her community. She states that she needs to “prioritise any free time I have so I can spend it with the kids, especially my oldest who is doing VCE this year”. She has two close friends at church who help with looking after her children when she has to work late or on weekends.

Ms Abimbola states that she tries to exercise when she has time and walks to the train station every day to get to work. It used to take 8 minutes each way but lately it takes at least 20 minutes including rest stops to catch her breath. She also does a lot of walking at the flour mill taking paperwork to the production supervisors and picking up reports for processing. However, she has had to ask one of the younger staff to get the reports and deliver the orders more and more over the last year or so as she get's too short of breath when she walks too far too quickly.

Ms Abimbola has not spoken to her husband since she and the children left him 6 years ago. She says he used to work at the flour mill but was sacked for being drunk at work eight years ago. He had a hard time finding work so drank heavily and became violent. She took the children and left him after he hit the middle child for spilling his coffee. She doesn't know where he lives and has had no contact with him for over 4 years.

Family history

Her father died from a stroke in 2005.

with the given case study of Ms Aaliyah Abimbola can you please

Q.N.1 Discuss the key elements of Step 1 of the CRC and why it is important by:

Q.N.2 developing and presenting a concept map of Ms Abimbola and her situation

Q.N.3 Including evidence to support the content of your concept map.

Read the case study, then answer the questions that follow.

Lee’s parents remember first noticing that Lee had some behavioural problems when he was only six years old. Although Lee was obviously an intelligent child he had developed various rituals that he needed to perform before undertaking routine daily tasks. He also found it difficult to interact in social situations. He maintained one close friendship since childhood but otherwise tends to be quite isolated from his peers.

When he was 14, Lee experienced a breakdown during a period of family stress. During this time Lee became quite violent towards both his parents and his sister. Lee regularly threatens self-harm. He has no social contact with anyone outside of his immediate family.

Lee spent six months in hospital following his breakdown and was subsequently diagnosed with bipolar disorder.

His parents are concerned about the way Lee is becoming increasingly violent and non-communicative. They worry that he is at risk of self-harm. Barbara is his support worker and is also noticing an escalation in violent behaviour in Lee. Barbara feels that the services Lee is currently accessing are not meeting his current needs and additional health professionals need to be involved in the support and care of Lee.

1. List appropriate referral services that may now need to be considered for Lee.

2. If Barbara was present at the time of Lee’s violent behaviour, what prompt actions could she take to support Lee? (Approx. 65 words that you can present in a bullet point list if you wish).

3.

what kind of leadership do you now think might be a best fit for the microsystem level, and why?

You are the RN on a morning shift on the respiratory ward of a large inner-city hospital. At 10:30 AM you receive a patient from the Emergency Department.

This is the hand-over you receive.

Your initial assessment findings on the ward for Ms Abimbola are as follows:

Medications

Metoprolol 100mg daily, Aspirin 100mg daily, Atorvastatin 20mg mane, Glibenclamide (Daonil) 5mg orally daily before breakfast, Salbutamol sulphate (Ventolin) 100mcg inhaler as required for symptom relief (1-2 puffs as required), Fluticasone propionate/salmeterol xinafoate (Seretide) 50/25 inhaler (2 puffs BD)

Current vital observations:

BP 142/96mmHg

HR 96bpm

RR 24 bpm

SpO2 93% on RA

T 36.7C

Health assessment findings:

Height 158cm, Weight 93kg,

Total cholesterol level - 5.2mmol/L

Fasting BGL - 9.6mmol/L

Inspiratory and expiratory wheeze. speaking in short phrases taking 2-3 breaths between each phrase before continuing to speak.

Alert and orientated to time, place, and person.

Further information you gather from her medical history and as part of her admission questions:

Ms Aaliyah Abimbola is a 56 year old female who emigrated from Africa 20 years ago. Ms Abimbola is a single parent with three female children (ages 14, 17 and 18) living in the inner-west of Melbourne.

Ms Abimbola went to her local health care clinic 2 weeks ago complaining of increasing shortness of breath and lack of energy. She says she was given some breathing medication (inhalers) by the doctor and told to take it easy for a few days. She has been struggling to get from the ground floor living area to the upstairs bedrooms without resting half-way to catch her breath. She says sometimes the medication helps her catch her breath but she still has to rest half way even with the medication.

Ms Abimbola has been working at the local flour mill since she arrived in Melbourne from Africa 20 years ago. She has never smoked but says the dust at the flour mill often makes her cough. Her job for the first 3 years was filling bags with flour until that process became fully automated. She then got promoted to running one of the flour grinding machines. 2 years later she got another promotion to shift supervisor in the milling and packaging section. She says her clothes were always covered in white dust at the end of every shift. "I used to look like a ghost at the end on my shift. We all did!" The flour mill made it mandatory to wear a mask and other protective equipment when you're working in the factory about eight years ago. However, Ms Abimbola has been working in the office for the last 6 years and no-one wears protective equipment in the office as it's not necessary. She says there's always a fine layer of dust on the paperwork in the office because the 'flour just gets everywhere no matter how often you clean or how careful you are."

Ms Abimbola is currently averaging 50 hours/week which means she needs to work on most weekends. Since the Covid 19 lockdown the factory has increased production to 24 hours a day 7 days a week. That means the office is also extremely busy. Ms Abimbola has always accepted any overtime on offer to help pay the rent for their house and cover the school fees for the Catholic school her children attend. She is adamant that she wants them to get a good education so they can make the most of the opportunities she never had in Africa. She has always been socially active within her Church community, but due to her increased working hours this has restricted her ability to attend mass and contribute to her community. She states that she needs to “prioritise any free time I have so I can spend it with the kids, especially my oldest who is doing VCE this year”. She has two close friends at church who help with looking after her children when she has to work late or on weekends.

Ms Abimbola states that she tries to exercise when she has time and walks to the train station every day to get to work. It used to take 8 minutes each way but lately it takes at least 20 minutes including rest stops to catch her breath. She also does a lot of walking at the flour mill taking paperwork to the production supervisors and picking up reports for processing. However, she has had to ask one of the younger staff to get the reports and deliver the orders more and more over the last year or so as she get's too short of breath when she walks too far too quickly.

Ms Abimbola has not spoken to her husband since she and the children left him 6 years ago. She says he used to work at the flour mill but was sacked for being drunk at work eight years ago. He had a hard time finding work so drank heavily and became violent. She took the children and left him after he hit the middle child for spilling his coffee. She doesn't know where he lives and has had no contact with him for over 4 years.

Family history

Her father died from a stroke in 2005.

Question

Q.N.1 Q.N.1 Discuss the key elements of Step 1 of the CRC and why it is important by

Q.N.2 Discuss the key elements of Step 2 of the CRC and why it is important.

Q.N.2 Discuss the pathophysiology of COPD and how Ms Abimbola's S&S reflect the underlying pathophysiology of the condition.

Complete a 1 page reflection. Include the following-

a. Are outcomes from similar simulation or real-life experiences that demonstrated effective teamwork and collaboration.

b. Discuss various roles and responsibilities of healthcare team members during a crisis.

c. Consider potential difficult communication situations and role-play new ways to best address these for positive client outcomes

• Why is scholarship important(not money you get for school)?

How can you disseminate scholarship in your practice (not money you get for school)?

A client who had mitral valve replacement surgery receives a prescription for dextrose 5% in water with 0.5 grams of dobutamine in 250 ml for IV infusion at a rate of 5 mcg/kg/minute. The client weighs 75 kg. The nurse should program the infusion pump to deliver how many ml/hr? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

Explain one way that your workplace and the healthcare field in general promote or hinder the practice of compassion for patients.

• Describe what herd immunity is.
• Find and describe Phase 3 of COVID-19 vaccine testing.
• Based on your knowledge of your family, or friends, or members of your community, describe what people think about receiving the COVID-19 vaccine. What should they see or hear be more convinced to get vaccinated?

Your patient has cardiovascular disease (CVD) and has been admitted with these vitals: BP 190/90, HR 100, RR 35. When asked about symptoms, the patient states, “I have a very bad headache and feel light headed.” History reveals he has had one heart attack three years ago. He is a pack a day smoker and often drinks more than one drink per day. When doing your morning assessment, you find a dime sized wound on his lower leg. The wound is open in the center and red around it. When asked, the patient states his feet and legs are cold much of the time and he no longer walks long distances because of pain in his legs.

Question: What is the most immediate concern for this patient and why? Include in your answer specific facts, data, examples, and other information drawn from your textbook

Alice Foote is an 84-year old nursing home patient with advanced dementia who develops kidney failure and is brought into the emergency room. Ms. Foote is currently semi-comatose from the kidney failure, which, like her dementia, was caused by her hypertensive vascular disease (i.e., hypertension). The kidney failure is irreversible; that is, there is nothing that can be done to restore the functioning of the kidneys. However, dialysis can compensate for the effects of the kidney failure by serving as her artificial kidney. The emergency room physician consults the nephrologist (kidney doctor) on-call about dialysis. The two physicians peruse Ms. Foote's medical record and find that, before developing kidney failure, Ms. Foote had been withdrawn and bedridden, was not able to recognize family or friends, and needed assistance for all basic activities, including feeding and bathing. They also discover that Ms. Foote had duly executed a Florida "Living Will" several years earlier, before she developed her dementia, after a lengthy discussion about end-of-life care with her physician. The Florida Living Will states: If at any time I am incapacitated and (initial all that apply) ___AF___ I have a terminal condition, or ___AF___ I have an end-stage condition, or ___AF___ I am in a persistent vegetative state and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. It is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal. The nephrologist considers starting Ms. Foote on chronic, thrice-weekly dialysis, which will restore Ms. Foote to her pre-kidney failure level of functioning. However, the nephrologist is reluctant to do so because of Ms. Foote's dementia, the cost of dialysis (more than $45,000 per year) and the fact that Ms. Foote's life expectancy even with dialysis is no more than a couple of years. The nephrologist tells the emergency room physician that dialysis is not an option and that Ms. Foote should be returned to the nursing home with instructions about basic comfort care. If Ms. Foote went back to the nursing home without dialysis, she would die, probably in three days. The emergency room physician has called the hospital's ethics committee for advice. You are on the hospital ethics committee, and the committee has asked you to investigate and report back to the committee on the ethical and legal considerations raised by Ms. Foote's situation. What would you say?

What is the novel coronavirus and why is it called coronavirus? How are coronaviruses transmitted between people? How can I protect myself against corona viruses?

Terri is a 28-year-old woman with a history of type 1 diabetes mellitus (TIDM), diagnosed when she was 5 years old. She has been brought into the emergency department this morning by her partner, Greg, as she is lethargic and unable to make any sense. Greg reports she has been unwell with a flu-like illness for the past week with nausea and vomiting over the past 2 days. Terri had decided not to take her usual insulin dose last night as she hadn't been eating and her blood sugar was only 8.1 mmol/L.

                On examination you find Terri has a Glasgow Coma Scale score (GCS) of 10 (eye opeming:3; verbal response :3; motor response:4); she has deep, rapid respirations, acetone smell on her breath and her skin is flushed ad dry. Greg reports she had gone to the toilet several times during the night and, when she woke up this morning, she had wet the bed. Her blood glucose level (BGL) is 42.1 mmol/L and her ketone levels are 7.1 mmol/L. Urinalysis shows large amounts of glucose and ketones with a low specific gravity. Her vital signs are:

• BP 102/54 mmHg
• Hr112 beats/minute
• Rr 36 breaths/minute, rapid and shallow
• T: 36.2 degree Celsius
• Spo2 96% with no supplemental oxygen

Medical staff suspect Terri has diabetic ketoacidosis (DKA) and order two large bore intravenous (IV) cannulae inserted for fluid resuscitation and IV insulin administration.

Phase 1

Terri has been in the emergency department for half an hour. An indwelling catheter is placed to closely monitor Terri's fluid balance while the diuresis continues. Terri is initially commenced on a rapid infusion of normal saline to replace fluid lost through the osmotic, diuresis and improve her BP. Medical staff have ordered the commencement of an IV insulin infusion to slowly decrease Terri's BGL and you access the hospital's protocol for this and prepare the infusion. Blood tests are taken to determine urea and electrolyte status as well as arterial blood gas analysis to assess the presence and extent of acidosis.

Although Terri's initial oxygen saturation levels were good, you apply a simple face mask with 6 L O2, supplemental oxygen as she is tachypnoeic and you want to optimise her FiO2. After receiving 2 L of normal saline, Terri's BP begins to improve. Her current vital signs are:

BP - 110/62 mmHg

HR - 102 beats/minute

RR - 34 breaths/minute, still rapid and shallow

T-37.2°C

Spo2 -97% with 6 LO via simple face mask

Phase 2                                                                                                                                                              

The results of the blood tests, received 30 minutes later, show Terri's potassium levels are 6.2 mmol/L. Her other electrolytes were within normal ranges. You immediately place her on a continuous electrocardiogram (ECG) monitor and take a 12-lead ECG, which shows high peaked T waves. Her ABG results are:

pH - 7.18

PaCO2 - 40 mmHg

HCO3 - 13 mmol/L

PaO2 - 125 mmHg

Base excess (BE) - 4 mEq/L

Sao2 - 95%

Twenty minutes after you take your initial ECG, Terri loses consciousness and her continuous ECG monitor shows a 6-second episode of ventricular tachycardia (VT), after which Terri regains consciousness, back to the original GCS 10 assessed on arrival. You notify medical staff and take another 12-lead ECG, which still shows peaked T waves, but no other abnormality. You monitor Terri closely for any further VT episodes. Her vital signs are:

BP - 106/62 mmHg

HR - 121 beats/minute

RR - 30 breaths/minute, still rapid and shallow

T -37.0°C

Spo2 -97% with 6 L 02 via simple face mask

Phase 3:

Terri has been treated for a total of 24 hours now. She has received IV fluid, which was switched to normal saline to Hartmann’s solution, after receiving 2 litres of normal saline, to ensure electrolytes were maintained; her IV insulin infusion continues. After 24 hours of treatment, Terri’s BGL is 31.3 mmol/L, ketones are 4.5 mmol/L and her potassium levels are now 3.2 mmol/L.

                ABG tests weretaken every hour for the first 6 hours, until her pH began to normalise, then every 2 hours. Her ABG is showing significant improvement and is currently:

-pH-7.34

-PaCO2-36 mmHg

-HCO2 -15 mmol/L

-PaO2- 105 mmHg

-BE- 3mEq/L

-SaO2-98%

A strict fluid balance chart was recorded and the indwelling catheter remained in place, for accurate urine output measurements, for 3 days until her condition stabilised. Her vital signs at present are:

-BP- 112/62 mmHg

-HR- 87 beats/min

-RR-22 breaths/min

-T- 37.1 °C

-SpO2-97% with 6 L O2 via simple face mask

Directions: Answer the following questions and cite references. Create a Nursing Care plan based on the case presented.

1. What condition explains the patient’s hypotension and diuresis? Discuss your answer.

2. What intravenous fluid/s is appropriate to treat this patient’s dehydration? Justify.

3. Discuss what has activated the renin– angiotensin– aldosterone mechanism?

4. Explain the physiology that triggered the patient to exhibit tachypnea.

5. Kindly interpret the patient’s ABG results. Explain your answers using up and down arrows, followed by a short narrative.

6. Justify the cause of the patient’s dysrhythmia.

7. Explain what should be monitored all throughout the patient’s stay.

8. Why is it important to maintain an accurate fluid balance record for this patient?

9. Please prepare a nursing care plan for Terri’s condition.